Table 1.

Comparison of GRADE and other systems

Factor	Other systems	GRADE	Advantages of GRADE system*
Definitions	Implicit definitions of quality (level) of evidence and strength of recommendation	Explicit definitions	Makes clear what grades indicate and what should be considered in making these judgments
Judgments	Implicit judgments regarding which outcomes are important, quality of evidence for each important outcome, overall quality of evidence, balance between benefits and harms, and value of incremental benefits	Sequential, explicit judgments	Clarifies each of these judgments and reduces risks of introducing errors or bias that can arise when they are made implicity
Key components of quality of evidence	Not considered for each important outcome. Judgments about quality of evidence are often based on study design alone	Systematic and explicit consideration of study design, study quality, consistency, and directness of evidence in judgments about quality of evidence	Ensures these factors are considered appropriately
Other factors that can affect quality of evidence	Not explicitly taken into account	Explicit consideration of imprecise or sparse data, reporting bias, strength of association, evidence of a dose-response gradient, and plausible confounding	Ensures consideration of other factors
Overall quality of evidence	Implicitly based on the quality of evidence for benefits	Based on the lowest quality of evidence for any of the outcomes that are critical to making a decision	Reduces likelihood of mislabelling overall quality of evidence when evidence for a critical outcome is lacking
Relative importance of outcomes	Considered implicitly	Explicit judgments about which outcomes are critical, which ones are important but not critical, and which ones are unimportant and can be ignored	Ensures appropriate consideration of each outcome when grading overall quality of evidence and strength of recommendations
Balance between health benefits and harms	Not explicitly considered	Explicit consideration of trade-offs between important benefits and harms, the quality of evidence for these, translation of evidence into specific circumstances, and certainty of baseline risks	Clarifies and improves transparency of judgments on harms and benefits
Whether incremental health benefits are worth the costs	Not explicitly considered	Explicit consideration after first considering whether there are net health benefits	Ensures that judgments about value of net health benefits are transparent
Summaries of evidence and findings	Inconsistent presentation	Consistent GRADE evidence profiles, including quality assessment and summary of findings	Ensures that all panel members base their judgments on same information and that this information is available to others
Extent of use	Seldom used by more than one organisation and little, if any empirical evaluation	International collaboration across wide range of organisations in development and evaluation	Builds on previous experience to achieve a system that is more sensible, reliable, and widely applicable

^*Most other approaches do not include any of these advantages, although some may incorporate some of these advantages.